Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality

Community-acquired pneumonia (CAP) is one of the major contemporary acute life-threatening conditions. Short-term mortality reaches 14% (7% if nursing-home residents and bedridden patients are excluded) and long-term mortality reaches 50% within 5 yrs. CAP and acute myocardial infarction (AMI) have a lot in common with regard to acuity, prognosis, need for risk stratification and early intervention, and secondary prevention measures. The obvious success in the treatment of AMI is due to an effective organisation of pre-hospital care and evidence-based interventions in the hospital within defined timescales. Less evidence is available about effective strategies to lower short- and long-term mortality in patients with CAP. Nevertheless, it is estimated that ∼ 30% of hospitalised patients with CAP could be subject to a management approach in parallel to that of acute coronary syndrome (ACS). Management of patients with severe CAP should be intensified using all elements that have been established in the care for patients with ACS and stroke. One of the main challenges of future research will be to define whether and which additional patients at risk of mortality truly profit from timely and structured interventions. In the meantime, patients at increased risk of death according to clinical prediction tools should also be subject to an aggressive management approach.